Executive Summary
Implementation of the “integration mandate” found in the U.S. Supreme Court’s decision in Olmstead v. L.C. (1999) has led to a significant reduction in the number of disabled people who are institutionalized or at risk of institutionalization across Georgia, North Carolina, and Virginia. Settlement agreements stemming from litigation and complaints spurred state funding for housing rental vouchers, which make market-rate units affordable for low-income disabled people who are members of the settlement groups.
These include people with intellectual and developmental disabilities (I/DD) and those who have serious and persistent mental illness (SPMI) or serious mental health disabilities. Olmstead settlements have also motivated additional state funding for supportive housing services and Medicaid waiver-funded Home- and Community-Based Services (HCBS) that many disabled people require to live successfully in the community.
These settlements have also prompted the creation of permanent, integrated, scatteredsite housing slots that afford tenancy rights. Slow-but-steady cultural changes and interagency collaborations within state governments and the support services sector, spurred by settlement goals, reflect a growing understanding of why community integration, choice, and agency are vital to people with diverse disabilities. Despite these advances, complex systemic barriers to community integration persist, including widespread shortages of affordable housing, lengthy waiting lists for specific HCBS, shortages in the direct care workforce, and state budget deficits. Moreover, recent deep federal reductions in funding threaten Medicaid HCBS, housing subsidies, and other programs that bolster Olmstead’s promise of integration.
This paper highlights the use of Olmstead as a tool for housing creation at the state and local level that has the potential to be emulated across the United States.